Objective: To explore the correlation between blind box consumption and non-suicidal self-injury(NSSI) among middle school students, so as to provide new theoretical insights for the prevention of NSSI. Methods: Using stratified random cluster sampling method, 2 807 middle school students aged 11-19 years old were selected from Hunan and Gansu provinces from November 2024 to March 2025. The blind box consumption questionnaire and Functional Assessment of Self mutilation Scale were administered to collect data on students blind box consumption frequency, as well as NSSI behavior. The χ 2 test was used to compare differences in the distribution of NSSI across different groups. Multivariate Logistic regression analysis was performed to infer the correlation and gender differences. Results: A total of 15.3% of middle school students reported having at least one NSSI incident in the past year, among which the reported rates of occasional NSSI (1-4 times) and repeated NSSI (≥5 times) were 5.5% and 9.8% respectively. The results of univariate analysis showed that there was statistically significant different in NSSI distribution among groups with different blind box consumption frequencies ( χ 2=55.72, P <0.05). After adjusting for confounding factors such as age, gender, school stage, family type, discipline style, pocket money, impulsiveness and emotion management, the results of multiple Logistic regression models showed that compared with the group without blind box consumption, the risks of "occasional NSSI" and "repeated NSSI" were higher in the group with blind box consumption ( OR =1.54, 1.66), and the frequency of blind box consumption(continous variable) was positively correlated with the risks of "occasional NSSI" and "repeated NSSI" among middle school students ( OR =1.26, 1.34)(all P <0.05).After gender stratification, the consumption behavior of blind boxes and the frequency of blind box consumption (continuous variable) of boys and girls were associated with "repeated NSSI"(boys: OR =1.61, 1.32, girls: OR =1.65, 1.35), and only in the male group was a correlation between blind box consumption and "occasional NSSI" observed ( OR =2.27) (all P <0.05). Conclusion Blind box consumption may be related to NSSI among middle school students, and there are gender differences in its correlation with NSSI among middle school students.

Klebsiella pneumoniae,as a clinically prevalent opportunistic pathogen,ranks as the second most com-monly detected pathogen in clinical isolates in China.The extensive clinical use of carbapenem antibiotics has led to a high global detection rate of carbapenem-resistant K.pneumoniae(CRKP).Characterized by complex resist-ance mechanisms and diverse evolutionary pathways,CRKP infections pose significant challenges in prevention and treatment,with high associated mortality rates,creating substantial obstacles for clinical anti-infective therapy.In recent years,the emergence and global spread of carbapenem-resistant hypervirulent K.pneumoniae(CR-hvKP)have escalated into a major public health threat.Notably,hypervirulent K.pneumoniae isolates carry-ing carbapenem resistance genes are rapidly disseminating worldwide,causing fatal infections even in immunocom-petent individuals.This article systematically reviews the latest research advances on the resistance mechanisms,evolutionary pathways,adaptive changes,and clinical management strategies of CR-hvKP,aiming to deepen un-derstanding of this"superbug"and provide a theoretical foundation for clinical prevention and control.

Objective To systematically evaluate the effect of threshold inspiratory muscle training on pulmonary rehabilitation in postoperative lung cancer patients,with a focus on exploring the difference in efficacy under different interven-tion modes.Methods Randomized controlled trials on the effect of threshold inspiratory muscle training on pulmonary rehabilitation in postoperative lung cancer patients were retrieved from PubMed,Cochrane Library,Embase,Web of Science,CNKI,Wanfang data,VIP and China Biomedical Literature Database.Meanwhile,gray literature from ProQuest and clinicaltrials.gov was searched as supplements.The retrieval period was from the establishment of each data-base to May 9,2025.Cochrane 5.1.0 was used to evaluate the quality of literature,and a meta-analysis was per-formed using RevMan 5.4.Results Twelve studies involving 701 patients were included,all of which were of moderate to high quality.Threshold inspiratory muscle training could reduce the pulmonary complications of postoperative lung cancer patients(OR=0.45,95%CI 0.29 to 0.68,P<0.001),shorten the hospital stay(MD=-1.85,95%CI-3.29 to-0.42,P=0.010),improve the inspiratory muscle strength(MD=5.84,95%CI 0.96 to 10.71,P=0.020),enhance their ex-ercise endurance(SMD=0.40,95%CI 0.10 to 0.71,P=0.010),and did not increase the risk of pulmonary air leakage(OR=0.88,95%CI 0.47 to 1.63,P=0.680).Subgroup analysis revealed that shortening of hospital stay(MD=-2.98,95%CI-5.87 to-0.09,P=0.040)and the improvement in exercise endurance(SMD=0.57,95%CI 0.14 to 1.00,P=0.009)were significant only when threshold inspiratory muscle training was combined with aerobic exercise.However,standalone threshold inspiratory muscle training showed no statistical signifi-cance in these two outcomes.Conclusion Threshold inspiratory muscle training can effectively reduce postoperative pulmonary complications and im-prove inspiratory muscle strength in postoperative lung cancer patients with good safety.Threshold inspiratory muscle training could shorten hospital stay and improve exercise endurance only when combining with aerobic exercise.

Objective To systematically evaluate the effect of threshold inspiratory muscle training on pulmonary rehabilitation in postoperative lung cancer patients,with a focus on exploring the difference in efficacy under different interven-tion modes.Methods Randomized controlled trials on the effect of threshold inspiratory muscle training on pulmonary rehabilitation in postoperative lung cancer patients were retrieved from PubMed,Cochrane Library,Embase,Web of Science,CNKI,Wanfang data,VIP and China Biomedical Literature Database.Meanwhile,gray literature from ProQuest and clinicaltrials.gov was searched as supplements.The retrieval period was from the establishment of each data-base to May 9,2025.Cochrane 5.1.0 was used to evaluate the quality of literature,and a meta-analysis was per-formed using RevMan 5.4.Results Twelve studies involving 701 patients were included,all of which were of moderate to high quality.Threshold inspiratory muscle training could reduce the pulmonary complications of postoperative lung cancer patients(OR=0.45,95%CI 0.29 to 0.68,P<0.001),shorten the hospital stay(MD=-1.85,95%CI-3.29 to-0.42,P=0.010),improve the inspiratory muscle strength(MD=5.84,95%CI 0.96 to 10.71,P=0.020),enhance their ex-ercise endurance(SMD=0.40,95%CI 0.10 to 0.71,P=0.010),and did not increase the risk of pulmonary air leakage(OR=0.88,95%CI 0.47 to 1.63,P=0.680).Subgroup analysis revealed that shortening of hospital stay(MD=-2.98,95%CI-5.87 to-0.09,P=0.040)and the improvement in exercise endurance(SMD=0.57,95%CI 0.14 to 1.00,P=0.009)were significant only when threshold inspiratory muscle training was combined with aerobic exercise.However,standalone threshold inspiratory muscle training showed no statistical signifi-cance in these two outcomes.Conclusion Threshold inspiratory muscle training can effectively reduce postoperative pulmonary complications and im-prove inspiratory muscle strength in postoperative lung cancer patients with good safety.Threshold inspiratory muscle training could shorten hospital stay and improve exercise endurance only when combining with aerobic exercise.

Klebsiella pneumoniae,as a clinically prevalent opportunistic pathogen,ranks as the second most com-monly detected pathogen in clinical isolates in China.The extensive clinical use of carbapenem antibiotics has led to a high global detection rate of carbapenem-resistant K.pneumoniae(CRKP).Characterized by complex resist-ance mechanisms and diverse evolutionary pathways,CRKP infections pose significant challenges in prevention and treatment,with high associated mortality rates,creating substantial obstacles for clinical anti-infective therapy.In recent years,the emergence and global spread of carbapenem-resistant hypervirulent K.pneumoniae(CR-hvKP)have escalated into a major public health threat.Notably,hypervirulent K.pneumoniae isolates carry-ing carbapenem resistance genes are rapidly disseminating worldwide,causing fatal infections even in immunocom-petent individuals.This article systematically reviews the latest research advances on the resistance mechanisms,evolutionary pathways,adaptive changes,and clinical management strategies of CR-hvKP,aiming to deepen un-derstanding of this"superbug"and provide a theoretical foundation for clinical prevention and control.

Terminally ill patients face multiple difficulties in home care.Home-based palliative care ad-hering to the concept of whole-person,whole-family,whole-team,and whole-course care is able to meet the needs of terminally ill patients and their families.In this paper,we reported the care history and home-based pal-liative care process of a patient with end-stage breast tumor and summarized the experience,aiming to provide reference for the future work of home-based palliative care.

Objective To describe the palliative care model in the Peking Union Medical College Hos-pital and provide a reference for the palliative care work in other general hospitals.Methods A field study was carried out at the Palliative Medicine Center of Peking Union Medical College Hospital.Data were collected by participatory observation,in-depth interviews,and physical collection,and the thematic analysis was performed to refine the themes and analyze the results.Results A total of 9 themes were obtained and the"Banyan Tree Model"was summarized.Conclusion The palliative care model in the Peking Union Medical College Hospital is suitable for the development of palliative care in general hospitals and has a reference value.

Objective To investigate the correlation between biofilm gene,efflux pump gene,biofilm forming ability and drug resistance of Acinetobacter baumarmii(AB)isolated from the patients of clinical infectious diseases.Methods A total of 119 non-repeating Acinetobacter baumannii isolates(74 MDR-AB strains and 45 non-multi-drug resistant strains)were collected.The effector pump genes(adeB,adeJ,adeG,adeS and adeR)and biofilm-related genes(bap,ompA,csuA,csuB,csuC,csuD,csuE,abaI,bfmR,bfmS)were detected by PCR.Bacterial biofilm was constructed in vitro with 24-well cell culture plates,and the formation of biofilm was qualitatively observed by crystal violet staining.Results Acinetobacter baumannii was resistant to most of the commonly used antibiotics and sensitive to tigacycline,polymyxin B and minocycline.The overall detection rate of biofilm-related genes was about 80％,and the detection rates of bap,csuB,csuC and csuD genes in multi-drug resistant bacteria were significantly higher than those in non-multi-drug resistant bacteria(P＜0.05).The detection rate of active effector pump genes was less than 70％,and the detection rate of adeB,adeJ,adeS and adeR genes in multidrug-resistant bacteria was significantly higher than that in non-multidrug-resistant bacteria(P＜0.05).The adeG carrying rate was opposite.Three multidrug-resistant strains and five non-multidrug-resistant strains did not carry the above efflux pump related genes,and no abeM gene was detected in all strains.The formation of biofilm was observed in 95.80％of strains.Conclusion Acinetobacter baumannii in hospital is mostly multidrug-resistant strains,most of which have strong biofilm forming ability.Multidrug-resistant bacteria have higher biofilm gene and effluent-pump gene carrying rate,which may be involved in the regulation and formation of multidrug resistance.

Objective:To explore the relationship between respiratory mechanics and right heart function during ARDS mechanical ventilation through the establishment of Beagle dogs acute respiratory distress syndrome (ARDS) animal model and the application of different levels of mechanical ventilation, which will provide theoretical basis for right heart protective ventilation strategy of ARDS.Methods:Beagle dogs were anesthetized successfully and then pulmonary artery floating catheter, esophageal manometric catheter and femoral artery catheter were inserted. Under the pressure control mode, the driving pressure was fixed. After adjustment, PEEP gradually increased from 2 cmH 2O to 14 cmH 2O. The changes of respiratory mechanics, hemodynamics and right heart function were observed. ARDS model was established by injecting oleic acid into central vein, and mechanical ventilation with the same parameters was given after the model was established successfully. In contrast to itself, the changes of respiratory mechanics, hemodynamics and right heart function indexes of experimental dogs before and after modeling were analyzed. In the group, the indexes of different PEEP were compared by ANOVA, and then compared by Student-Newman-Keuls. The difference was statistically significant at a P value <0.05. Results:Before modeling, the peak airway pressure (P peak) and plateau pressure (P plat) increased with the increase of PEEP ( F=232.733,196.33, P<0.05). However, P trans-I, P trans-E, C stat and Vt decreased significantly ( F=4.524, 6.499, 64.803, 2.31, P<0.05). The area of change of right ventricle (FAC) became smaller ( F=3.09, P<0.05); SV first increased and then decreased ( F=3.24, P<0.05), and CVP and MPAP increased ( F=19.07,14.81, P<0.05). There was no significant difference in TAPSE, MAP, HR and SpO 2 ( P>0.05). After modeling, as PEEP increased, P peak, P plat, P ES-I and P ES-E increased significantly ( F=24.829, 41.95, 9.78, 87.86, P<0.05). Vt, P trans-I, P trans-E, C stat and Vt first increased and then decreased ( F=2.91, 4.29, 5.84, 48.890, P<0.05). TAPSE and SV first increased and then decreased ( F=6.22,6.54, P<0.05). CVP and MPAP increased ( F=5.23, 19.24, P<0.05). MAP increased first and then decreased ( F=5.02, P<0.05). SpO 2 increased ( F=2.77, P<0.05). FAC and HR had no statistical significance ( P>0.05). Conclusions:Trans pulmonary pressure and lung compliance can reflect the effectiveness of ARDS lung recruitment, and have good synergy; with the increase of PEEP, the right ventricular systolic function TAPSE is first affected, and SV compensatory increase, but with the increase of PEEP, TAPSE and SV decrease; pulmonary blood flow distribution is more important in improving alveolar oxygenation. Therefore, real-time monitoring of trans pulmonary pressure, TAPSE and intrapulmonary blood flow should be performed in ARDS treatment.

To examine the association between serum copper concentration and the prevalence of hypertension in patients with knee osteoarthritis (OA).
 Methods: A total of 935 patients who were aged ≥40 years and underwent routine checkups from October 2013 to November 2014 at the Health Management Center of Xiangya Hospital, Central South University were included. They were diagnosed as knee OA by weight-bearing bilateral anteroposterior radiography. Serum copper concentration was measured using the chemiluminescence method. Blood pressure was measured by an electronic sphygmomanometer. The association between serum copper concentration and hypertension was evaluated by conducting multivariable adjusted logistic regression.
 Results: Compared with the lowest quintile, the multivariable-adjusted odds ratio (OR) and related 95% confidence interval (95% CI) of hypertension were 1.46 (95% CI 1.02 to 2.09, P for trend=0.035) and 1.47 (95% CI 0.77 to 2.78, P for trend=0.032) in the total population and female subgroup of the highestest quintile, respectively. There was no significant association between serum copper and hypertension in male subgroup among OA patients (OR=1.21, 95% CI 0.76 to 1.93, P for trend=0.354).
 Conclusion: The serum copper concentration was significantly associated with the prevalence of hypertension in total population and female subgroup, but may not in male subgroup among patients with knee OA.
Adult ; Copper ; Cross-Sectional Studies ; Female ; Humans ; Hypertension ; complications ; Male ; Odds Ratio ; Osteoarthritis, Knee ; complications ; Risk Factors